(Bleated) Monday Series: A Disease With No Remedy VI

The British physicians as well, discussed the nature of hereditary transmission of phthisis, loosely gathering into opposing camps of solidists and humoralists.[1] Although the Dutch Hermann Boerhaave had already classified disorders either as congenital or connate, medical men in Britain who were interested in hereditary transmission debated on the possible causal routes of diseases in order to establish clear criteria for recognizing hereditary diseases. As López-Beltrán mentions, these physicians debated on categorizing hereditary diseases—those identified as constitutional—with those “acquired” after conception (congenital and post-natal), forcing discussions of “original source, chronology of appearance and recurrences, and permanence (or chronicity).”[2] Recognizing the importance for categorizing hereditary distinctions appropriately, London surgeon Joseph Adams (1755-1818) wrote in 1815 that the peculiarity of constitution, as defined either as family or hereditary, was often mistakenly used synonymously. It was Adams that comprehensively adopted the French notions of hereditary diseases for the English audience.

Historian Elizabeth Lomax points out that Adams did not confine himself to a single cause for phthisis, but suggested that factors associated with poverty, such as poor diet and cold, were probably involved. He discovered no new empirical facts, Lomax claims, but his historical relevance is in his reclassification of diseases thought to be hereditary on the basis of their national history.[3] Familial constitution and hereditary constitution, Adams argues, are distinct, with the former referring to constitutional diseases confined to a single generation, and the latter traced from generation to generation. Adams also significantly contributed to British discussions on hereditary transmission by building upon Boerhaave’s distinctions, and clarifying the differences between dispositions and predispositions. He wrote:

constitutional dispositions are more commonly confined to brothers and sisters, than hereditary and that, whether family or hereditary, they always show themselves at an early period of life.[4]

In addition, Adams concluded that connate diseases were not hereditary, and hereditary predispositions can be brought up either climate, or other external causes, which can prevent the diseases’ emergence.[5] Other members of the British school, including William Stark (1742-71), Matthew Baillie (1761-1823) and Thomas Young also advocated ideas of individual susceptibility. Yet, after Adams, “barely a single a single discussion of hereditary malady written during the nineteenth century failed to elucidate the concept of predisposition.”[6]

Medical hereditarianism did not affect British social attitudes on degeneracy in the later Georgian period as it did on the French. Hereditary disease was mainly concerned in regards to familial traits, for distinguishing pedigree data and protecting future progeny against hereditary taint. The fear of marrying into hereditary tainted families was well-established by the late eighteenth century, as parents and relatives examined potential suitors for evidence of chronic disease.[7] “Is tuberculosis a ‘family’ disease?” J.B. Huber asked in 1906; “In many instances it is so—so often that the fact is unquestionable.”[8] But unlike the French, the British were slow in adopting ideological basis for hereditary transmission, with the British adoption of hérédité occurring between 1860 and 1870; in part, one can argue this was due to the slow reception of general ideas of inheritance—particularly Lamarckian and Buffonian influences—but one can also argue that British physicians generally accepted ideas of hereditary illness, without the same agitation between the profession as the French medical men did, though it is not to say these ideas were passively accepted. Physicians such as Adams, James Pritchard, and William Cullen fiercely contributed to the study of hereditary transmission of diseases, though they did not shake the social atmosphere as violently as the French.

Conclusions

Through their disputes over hereditary maladies, eighteenth century French physicians clarified the casual structure of hereditary transmission that gave early generations of nineteenth century physicians in Britain and France a comprehensive account to build their theories of heredity. This series examined the ideological basis of medical hereditarianism upon social and moral attitudes, by arguing that on one hand, the notion of hereditary transmission, while presenting itself as incurable, gave physicians creative room to develop new theories of heredity and disease transmission, including “predisposition;” and on the other hand, these ideas were generally accepted due to their attractive framework for explaining social ills. Thus, the concept of hereditary disease maintained a paradigmatic status in due part to its ability to play a more diffused social role.

[3] E. Lomax, “Hereditary or Acquired Disease? Early Nineteenth Century Debates on the Cause of Infantile Scrofula and Tuberculosis.” Journal of the History of Medicine and Allied Sciences 32 no.4 (Oct. 1977), 363. In addition, Lomas points out that Adams implied that supposedly hereditary diseases could be avoided once the precipitating causes had been discovered; further, he did not deny the possibility of hereditary transmission of disease, but “reiterated that the concept had been abused by Portal” (363).

[5] Under the solidist theory that was prevalent at Adam’s time, congential influences were the only truly kind of hereditary characters. López-Beltrán points out that by the late eighteenth century, “the notion of a general and unified explanation of hereditary transmission of both normal and pathological features was facilitated then by the strengthening of solidism” (“The Medical Origins of Heredity,” 121).

[6] J.C. Waller, “The Illusion of Explanation: The Concept of Hereditary Disease, 1770-1870.”Journal of the History of Medicine 57 (2002), p.420.